Provider Demographics
NPI:1548218787
Name:HSU, JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 BUTLER PIKE
Mailing Address - Street 2:SUITE
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1560
Mailing Address - Country:US
Mailing Address - Phone:800-331-6634
Mailing Address - Fax:267-420-1360
Practice Address - Street 1:4060 BUTLER PIKE
Practice Address - Street 2:SUITE
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1560
Practice Address - Country:US
Practice Address - Phone:800-331-6634
Practice Address - Fax:267-420-1360
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECL-0008438207W00000X
NJ25MA08241800207W00000X
PAMD426030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101277944-0001Medicaid
NJ0070581Medicaid
DE1548218787Medicaid
I29215Medicare UPIN
DE146277ZCWYMedicare PIN
PAP00443515Medicare PIN
PA101277944-0001Medicaid
PA090800EV6Medicare PIN
NJ119276AHDMedicare PIN
PAP00443515Medicare PIN
NJ119276C9YMedicare PIN
PA090800EV6Medicare PIN
DE1548218787Medicaid
PA090800QOTMedicare PIN